Modifier -25, Significant, separately identifiable evaluation and management service by the same
physician on the same day of the procedure or other service:
This modifier must be appended with an E/M service. This is the modifier you will need to use with
the evaluation and management service done on the same day with other procedure done by the
same physician. It has to be above and beyond the usual preoperative and postoperative
encounter with the procedure. In fact, by using this modifier, it doesn't have to have a different
diagnosis reported. The most important thing is that, the E/M level should meet its key
components or if it is selected based on time spent with the patient (counseling and coordination
of care). You have to be careful in using this modifier. It must meet medical necessity. As you
know, there are procedures that already includes all other coordination of care and management.
Let's describe this modifier 25:
A patient came in for her monthly follow up for her chronic back pain. At the same time, patient was
complaining with severe headache. The pain doctor performed bilateral occipital block on the
patient at the time of service. You will append modifier 25 for the E/M code to indicate that both
services were rendered on the same day.
You don't use modifier 25 with E/M encounter that resulted to Decision for Surgery (we have
another modifier for this!)
Sample Encounter 2:
The patient came in to the office for her scheduled 2nd therapeutic knee injection. On the same
day, she presented herself as complaining with neck pain that has been bothering her sleep for
the past 3 days. The physician then added a separate E/M service.
Codes: 99213-25
20610
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
*** CPT codes and its descriptions are copyrights, owned, maintained and is a trademark of the
AMA (American Medical Association).
*** Always consult your CPT Code Book! and the NCCI Edits
*** Get more information on clinical guidelines and policies from your local CMS carriers and from
your third party payors
*** You can purchase CPT Code books and CPT Assistants issues from the AMA's Bookstore!
|
|
